scholarly journals Healthcare-Associated Infections: Enterobacteriaceae Bloodstream Infections in the ICU Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s246-s247
Author(s):  
Marta KŁOS ◽  
Monika Pomorska-Wesołowska ◽  
Dorota Romaniszyn ◽  
Agnieszka Chmielarczyk ◽  
Jadwiga Wojkowska-Mach
Keyword(s):  
Drug Resistance ◽  
Hospital Care ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
High Rate ◽  
Diffusion Method ◽  
Resistance Testing ◽  
High Level ◽  
Healthcare Associated ◽  
Hospital Acquired

Background: Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). Objectives: We aimed to describe the epidemiology and drug resistance of hospital-acquired Enterobacteriaceae BSIs and to check for any correlation with the type of hospital care. Methods: In 2015–2018, 333 Enterobacteriaceae isolates were collected from hospitalized internal medicine and surgical patients. The drug-resistance testing was conducted according to the EUCAST recommendations, using the disc-diffusion method to determine resistance to penicillin, cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and sulfamethoxazole with trimethoprim. Tests confirming the presence of extended-spectrum β-lactamases (ESBLs) and KPC, NDM, and OXA-48 carbapenemases were performed. We determined the minimum inhibitory concentration (MIC) values (mg/L) for selected antibiotics. To detect the resistance genes, a single PCR reaction, a multiplex PCR, and a real-time PCR were conducted. Results: The prevalence rate of Enterobacteriaceae bacilli in BSIs was 23.5%. Penicillin resistance remained at a very high level of almost 100%, with only the piperacillin-tazobactam resistance remaining at 19%–22%. The same was true for cephalosporins: the bacilli have only shown a high susceptibility to cefoperazone with sulbactam (4%–14% of them were resistant). Ciprofloxacin (53%–62%) and sulfamethoxazole with trimethoprim (48–55%) have proven highly resistant. Carbapenems were the only antibiotics with susceptibility at 98%–99%. No difference was found between the types of hospital care (surgical vs nonsurgical) and the levels of antimicrobial resistance in the studied Enterobacteriaceae isolates (Table 1). Conclusions: The high prevalence of Enterobacteriaceae bacilli in BSI is particularly worrying, as is the high rate of resistance to cephalosporins and aminoglycosides, which are often used in the empirical therapy. Unfortunately, our results indicate the need to base the empirical therapy on carbapenems.Funding: This work was supported by a grant from Jagiellonian Univerity Medical School (No. N41/DBS/000053)Disclosures: None

scholarly journals Antimicrobial Resistance in Enterobacterales Bacilli Isolated from Bloodstream Infection in Surgical Patients of Polish Hospitals

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
M. Kłos ◽  
M. Pomorska-Wesołowska ◽  
D. Romaniszyn ◽  
J. Wójkowska-Mach ◽  
A. Chmielarczyk
Keyword(s):  
Drug Resistance ◽  
Surgical Site Infection ◽  
High Resistance ◽  
Antimicrobial Agents ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Surgical Patients ◽  
Site Infection ◽  
M Gene ◽  
Hospital Acquired

Background and Aims. Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). We sought to describe the epidemiology and drug resistance secondary Enterobacterales BSIs in surgical patients and check for any correlation with the type of hospital ward. Materials and Methods. This multicenter (13 hospitals in southern Poland) laboratory-based retrospective study evaluated adults diagnosed with BSI secondary to surgical site infection (SSI) hospitalized in 2015–2018; 121 Enterobacterales strains were collected. The drug resistance was tested according to the EUCAST recommendations. Tests confirming the presence of extended-spectrum β-lactamases (ESBLs) and bla resistance genes were carried out. The occurrence of possible clonal epidemics among K. pneumoniae strains was examined. Results. The prevalence of Enterobacterales in secondary BSI was 12.1%; the most common strains were E. coli (n = 74, 61.2%) and Klebsiella spp. (n = 33, 27.2%). High resistance involved ampicillin and ampicillin/sulbactam (92, 8–100%), fluoroquinolones (48–73%), and most cephalosporins (29–50%). Carbapenems were the antimicrobials with the susceptibility at 98%. The prevalence of ESBL strains was 37.2% (n = 45). All the ESBL strains had blaCTX-M gene, 26.7% had the blaSHV gene, and 24.4% had blaTEM gene. The diversity of Klebsiella strains was relatively high. Only 4 strains belonged to one clone. Conclusions. What is particularly worrying is the high prevalence of Enterobacterales in BSI, as well as the high resistance to antimicrobial agents often used in the empirical therapy. To improve the effectiveness of empirical treatment in surgical departments, we need to know the epidemiology of both surgical site infection and BSI, secondary to SSI. We were surprised to note high heterogeneity among K. pneumoniae strains, which was different from our previous experience.

scholarly journals Appropriateness of antibiotics for medical prophylaxis: evaluation of data from the Italian PPS-2

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Cremona ◽  
J Garlasco ◽  
I Gintoli ◽  
A D'Ambrosio ◽  
F Quattrocolo ◽  
...  
Keyword(s):  
Empirical Therapy ◽  
Infectious Complications ◽  
High Rate ◽  
National Guidelines ◽  
Prevalence Survey ◽  
Inappropriate Use ◽  
Healthcare Associated ◽  
Evaluation Of Data ◽  
The Eu ◽  
Made In

Abstract Background Antibiotics (AB) are administered for medical prophylaxis (MP) to prevent infectious complications. The second national point prevalence survey (PPS) of healthcare-associated infections and AB use was conducted in Italy in 2016-2017. The survey found MP accounted for nearly 25% of all registered ABs, more than twice the EU/EEA proportion. The aim of this study was to evaluate how many ABs were administered for MP and how frequently general indications were followed. Methods Data from the PPS were used to evaluate the prevalence of indications for MP over the total number of ABs, the proportion - among these indications - of those justified by a motivation in the patients' charts, and the prevalence of ABs considered appropriate for MP. The evaluation was made in 12 hospitals out of 14 participating in the PPS in Piedmont, chosen on the basis of patient traceability. According to national guidelines, the indications for MP that were considered appropriate in this study were: Trimethoprim/sulfamethoxazole for P. carinii pneumonia, Rifaximin for diverticulitis, Penicillin for Streptococcal infections and for splenectomized patients, and Rifampin for TB infections. Results 1844 AB prescriptions were registered among 1334 traceable inpatients in Piedmont. The prevalence of indications for MP was 16.2% and 253 ABs (84.6%) were prescribed with a motivation. Only 3% of ABs registered as MP were appropriate for this indication: Bactrim 2%, Rifaximin 0.3%, Penicillin 0.2% and Rifampin 0.4%. Conclusions This study found an extremely high rate of inappropriate ABs for MP, that will be further investigated through qualitative analysis of medical records to evaluate whether a misunderstanding of the PPS protocol occurred and empirical therapy was confused with MP. Nevertheless, this study highlighted the need for interventions to improve prescribing appropriateness for MP. Key messages This study found that only 2.98% of ABs registered as MP among traceable patients in Piedmont were appropriate for this indication. 15.38% of prescriptions for MP were not justified by a motivation. Interventions to improve prescribing appropriateness for MP could lead to a considerable reduction in inappropriate use of ABs, which is crucial in a country facing hyperendemic levels of AMR.

scholarly journals The prevalence of resistance to macrolides and lincosamides among community- and hospital- acquired staphylococci and streptococci isolates in southeast Serbia

2018 ◽  
Vol 146 (7-8) ◽  
pp. 384-390
Author(s):  
Milena Misic ◽  
Aleksandra Arsovic ◽  
Jelena Cukic ◽  
Milenko Rosic ◽  
Jelena Tosic-Pajic ◽  
...  
Keyword(s):  
Empirical Therapy ◽  
Local Area ◽  
Diffusion Method ◽  
Streptococcal Infections ◽  
Coagulase Negative Staphylococci ◽  
Disk Diffusion Method ◽  
Inducible Clindamycin Resistance ◽  
Drug Of Choice ◽  
One Year ◽  
Hospital Acquired

Introduction/Objective. The increasing resistance to macrolides and lincosamides among staphylococci and streptococci is becoming a global problem. The aim of this study was to investigate the prevalence of macrolide-lincosamide-streptogramin (MLS) resistance phenotypes in staphylococcal and streptococcal isolates in southeast Serbia. Methods. The MLS phenotypes were determined by the double-disk diffusion method in 2,121 inpatient and outpatient staphylococcal and streptococcal isolates collected during a one-year period at the Center for Microbiology. Results. The methicillin-resistant staphylococci isolates were significantly more resistant to penicillin, erythromycin, clindamycin, gentamicin, and ciprofloxacin (100%, 100%, 29.2%, 65.6%, and 53.1%, respectively) than the methicillin-sensitive ones (93.6%, 64.9%, 12%, 28.9%, and 11.7%, respectively). The inducible clindamycin resistance phenotype was dominant in S. aureus and coagulase-negative staphylococci isolates. S. pneumoniae, S. pyogenes, and S. agalactiae isolates showed very high resistance to erythromycin (77.8%, 46.2%, and 32.4%, respectively). All staphylococci and streptococci isolates were sensitive to vancomycin and linezolid, and all beta-hemolytic streptococci isolates to penicillin and ceftriaxone. Conclusion. The phenotypic triage of staphylococci is necessary in order to separate inducible resistant and truly clindamycin-sensitive isolates. Macrolides should not be recommended for empirical therapy of streptococcal infections. Penicillins remain the drug of choice for treatment of streptococcal infections in our local area.

scholarly journals Etiological agents of diarrhea in hospitalized pediatric patients with special emphasis on diarrheagenic Escherichia coli in North India

2019 ◽  
Vol 11 (01) ◽  
pp. 068-074 ◽  
Author(s):  
Sheetal Verma ◽  
Vimala Venkatesh ◽  
Rashmi Kumar ◽  
Saurabh Kashyap ◽  
Manoj Kumar ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Drug Resistance ◽  
Antimicrobial Resistance ◽  
World Health ◽  
Polymerase Chain Reaction Test ◽  
Diffusion Method ◽  
Resistance Testing ◽  
First Line ◽  
E Coli ◽  
Etiological Agents

Abstract INTRODUCTION: Infectious diarrhea is leading infectious cause of childhood morbidity, hospitalizations, and mortality particularly in children living in developing countries like India. The etiological agents differ depending on geographical area, and recent data suggest increase in drug resistance to various enteropathogens. AIMS AND OBJECTIVES: The aim of the study was to investigate emerging diarrheal agents and antimicrobial resistance profile of bacterial pathogens from children (<12 years of age) hospitalized with acute diarrhea. MATERIALS AND METHODS: A cross-sectional, hospital-based observational study was conducted over 1 year in which 100 children <12 years who were hospitalized due to diarrhea were recruited. Diarrhea was defined as the passage of three or more liquid stools in a 24-h period using the World Health Organization guidelines. Samples were processed for detection of various bacterial, viral, and parasitic agents by standard microbiological, serological, and molecular tests. Antimicrobial resistance testing was performed with the Kirby–Bauer disk diffusion method. ELISA was performed for Rotavirus and Escherichia coli O157. Multiplex polymerase chain reaction test was performed to detect diarrheagenic E. coli (DEC). RESULTS: Pathogenic diarrheal agents were found in 63% patients. Rotavirus was identified in 52.5%, DEC in 29%, Vibrio cholerae in 4%, Shigella flexneri in 3%, Aeromonas sp. in 1%, Giardia lamblia in 4%, and Entamoeba histolytica in 1% cases. Enteropathogenic E. coli (EPEC) in 19 (65.5%) cases was the most common agent followed by Enteroaggregative E. coli (EAEC) in 5 (17.2%), Enterotoxigenic E. coli (ETEC) in 2 (6%), and Enteroinvasive E. coli (EIEC) in 3 (10.3%) cases. Resistance rates of DEC to first-line therapeutic drugs were high, 97.3% to ampicillin and 95.95% to co-trimoxazole. DEC was susceptible to chloramphenicol in 58.11%, gentamicin in 48.19%, and amikacin in 58.11% cases. Shigella sp. and V. cholerae isolates were 100% sensitive to gentamicin and ofloxacin. CONCLUSION: EPEC is the most common DEC pathotype and EAEC, ETEC, and EIEC are also emerging as dominant diarrheal agents. Rotavirus was the most common causative agents of diarrhea especially in children <5 years. Most of the bacterial isolates showed high level of drug resistance to first-line empirical drugs and were multidrug resistant making them unsuitable for empiric treatment. Laboratory monitoring of drug susceptibility of stool isolates appears necessary to formulate antibiotic policy for treating diarrheal illness at the local level. There is an urgent need to strengthen diarrheal surveillance to monitor susceptibility to commonly prescribed antibiotics.

scholarly journals Bacterial infections in cirrhosis: a narrative review and key points for clinical practice

2020 ◽  
Vol 14 (3) ◽  
pp. 126-135
Author(s):  
Mario Mitra ◽  
Andrea Mancuso ◽  
Flavia Politi ◽  
Alberto Maringhini
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Infections ◽  
Empirical Therapy ◽  
Multidrug Resistant ◽  
High Rate ◽  
First Episode ◽  
Bacterial Peritonitis ◽  
Prophylactic Measures ◽  
Tract Infections ◽  
Healthcare Associated

Bacterial infections are frequent complications of liver cirrhosis, accounting for severe clinical courses, and increased mortality. The reduction of the negative clinical impact of infections may be achieved by a combination of prophylactic measures to reduce the occurrence, early identification, and management. Spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, cellulitis, and spontaneous bacteremia are frequent in cirrhosis. The choice of initial empirical antimicrobial therapy should be based on both site, severity, and origin of infection (community-acquired, nosocomial, or healthcare-associated) and on antibiotic resistance patterns. 3rd generation cephalosporins are generally indicated as empirical therapy in most community-acquired cases. However, for nosocomial and healthcare-associated infections, due to a high rate of multidrug-resistant (MDR) pathogens, a broader spectrum treatment is appropriate. In order to prevent antibiotic resistance emergence, microbiological cultures should be collected, and a de-escalation applied when antimicrobial susceptibility tests are available. Standard measures to prevent infections and the identification of carriers of MDR bacteria are essential strategies to prevent infections in cirrhosis. Antibiotic prophylaxis should be applied only to gastrointestinal bleeding, SBP recurrence prevention, and cirrhotics at high risk of a first episode of SBP.

scholarly journals The Bacteriological Quality, Safety, and Antibiogram ofSalmonellaIsolates from Fresh Meat in Retail Shops of Bahir Dar City, Ethiopia

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Melkamnesh Azage ◽  
Mulugeta Kibret
Keyword(s):  
Drug Resistance ◽  
Multiple Drug Resistance ◽  
Disease Outbreaks ◽  
High Rate ◽  
Personal Hygiene ◽  
Diffusion Method ◽  
Multiple Drug ◽  
Bahir Dar ◽  
Disk Diffusion Method ◽  
Fresh Meat

The habit of raw meat consumption in addition to the poor hygienic standards and lack of knowledge contribute to food-borne diseases outbreaks. The objective of this research was to assess the bacterial quality and safety of fresh meat from retail Bahir Dar City, Ethiopia. A total of 30 fresh meat samples were collected from butcher shops. Standard bacteriological methods were used to isolate and enumerate bacteria. Kirby-Bauer disk diffusion method was used for antimicrobial susceptibility testing ofSalmonellaisolates. The mean counts of AMB, TC, andS. aureuswere log104.53, 3.97, and 3.88 log10cfu/g, respectively.Salmonellawas isolated from 21 (70%) of the samples.Salmonellaisolates in this study were highly susceptible to ciprofloxacin, gentamycin, and norfloxacin while they were resistant to erythromycin and tetracycline. High rate of multiple drug resistance was also noticed inSalmonellaisolates. The microbial loads of meat were above the recommended microbial safety limits. Besides this, the isolation rate ofSalmonellawas high and high levels of drug resistance were documented forSalmonellaisolates. Measures on handling and appropriate personal hygiene practices of workers in the retail shops are recommended to reduce the change of forborne disease outbreaks.

scholarly journals Monitoring of HIV Drug Resistance Mutations in Newly Diagnosed Patients in Cyprus (2010–2012)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S424-S424
Author(s):  
Ioannis Demetriades
Keyword(s):  
Drug Resistance ◽  
Phylogenetic Trees ◽  
Resistance Mutation ◽  
Drug Resistance Mutation ◽  
High Rate ◽  
Resistance Testing ◽  
Newly Diagnosed ◽  
Resistance Mutations ◽  
Subtype B ◽  
Hiv 1

Abstract Background A molecular epidemiology study of HIV-1 infection was conducted in 100 HIV-1 diagnosed and untreated patients in Cyprus representing 65.4 percent of all the reported HIV-1 infections in Cyprus between 2010 and 2012. Methods Eighty-two patients were newly diagnosed (genotypic drug resistance testing within six months from diagnosis), and 18 patients were HIV-1 diagnosed for a longer period or the diagnosis date was unknown. Results Phylogenetic trees of the pol sequences obtained in this study with reference sequences indicated that subtypes B and A1 were the most common subtypes present and accounted for 41.0 and 19.0% respectively, followed by subtype C (7.0%), F1 (8.0%), CRF02_AG (4.0%), A2 (2.0%), other CRFs (7.0%) and unknown recombinant forms, URFs (12%). Most of newly-diagnosed study subjects were Cypriots (63%), males (78%) with median age 39 (Interquartile Range, IQR 33–48) reporting having sex with other men, MSM (51%). Conclusion A high rate of clustered transmission of subtype B drug-sensitive strains to reverse transcriptase and protease inhibitors was observed among MSM. Twenty-eight out of forty-one MSM study subjects (68.0%) infected were implicated in five transmission clusters, two of which are subtype A1 and three subtype B strains. The two largest MSM subtype B clusters included nine and eight Cypriot men, respectively, living in all major cities in Cyprus. There were only three newly diagnosed patients with transmitted drug resistant HIV-1 strains, one study subject from the United Kingdom infected with subtype B strain and one from Romania with subtype A2 strain, both with the PI drug resistance mutation M46L and one patient from Greece with subtype A1 strain with the NNRTI drug resistance mutation K103N. Disclosures All authors: No reported disclosures.

Classification of bloodstream infections in patients recently discharged from acute-care facilities: Hospital acquired or healthcare-associated community onset?

2019 ◽  
Vol 40 (11) ◽  
pp. 1313-1315
Author(s):  
Riad Khatib ◽  
Mamta Sharma ◽  
Mohamad G. Fakih ◽  
Kathleen M. Riederer ◽  
Leonard B. Johnson
Keyword(s):  
Acute Care ◽  
Bloodstream Infections ◽  
Infection Risk ◽  
Care Facilities ◽  
Discharged Patients ◽  
Acute Care Facilities ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
Community Onset

AbstractLaboratory-identified bloodstream infections (LAB-ID BSIs) in recently discharged patients are likely to be classified as healthcare-associated community-onset (HCA-CO) infections, even though they may represent hospital-onset (HO) infections. A review of LAB-ID BSIs among patients discharged within 14 days revealed that 109 of 756 cases (14.4%) were HO infections. The BSI risk being misclassified as HCA CO may underestimate the hospital infection risk.

scholarly journals Predictors of mortality and clinical characteristics among carbapenem-resistant or carbapenemase-producing Enterobacteriaceae bloodstream infections in Spanish children

2020 ◽  
Vol 76 (1) ◽  
pp. 220-225 ◽  
Author(s):  
M F Ara-Montojo ◽  
L Escosa-García ◽  
M Alguacil-Guillén ◽  
N Seara ◽  
C Zozaya ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Paediatric Population ◽  
Carbapenem Resistant ◽  
Paediatric Cohort ◽  
Single Centre Study ◽  
Sources Of Infection ◽  
Underlying Diseases ◽  
Hospital Acquired

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) are an emerging problem in the paediatric population worldwide with high mortality rates in bloodstream infection (BSI). Objectives To evaluate predictors of 30 day mortality in CRE BSI in a paediatric cohort. Methods A retrospective observational single-centre study (December 2005–August 2018) was conducted. Cases of CRE BSI in children 0 to 16 years were included. Microbiological identification (MALDI Biotyper) and antimicrobial susceptibility testing (Vitek2® and MicroScan panel NBC44) according to EUCAST breakpoints were performed. PCR OXVIKP® was used to confirm carbapenemase genes (OXA-48, VIM, KPC, NDM). Demographic characteristics, underlying diseases, source of bacteraemia, antimicrobial therapy and outcomes were collected from medical records. Survival analysis to establish predictors of 30 day mortality was performed. Results Thirty-eight cases were included; 76.3% were hospital-acquired infections and 23.7% related to healthcare. All patients had at least one underlying comorbidity and 52.6% were recipients of an organ transplant. VIM carbapenemase was the predominant mechanism (92.1%). Previous CRE colonization or infection rate was 52.6%. Intestinal tract (26.3%) and vascular catheter (21.1%) were the most common sources of infection. Crude mortality within 30 days was 18.4% (7/38); directly related 30 day mortality was 10.5%. Conditions associated with an increment in 30 day mortality were intensive care admission and inadequate empirical therapy (P &lt; 0.05). Combination-antibiotic targeted treatment and a low meropenem MIC were not related to improved survival. Conclusions CRE BSI mortality rate is high. The most important factor related to 30 day survival in our CRE BSI cohort in children was empirical treatment that included at least one active antibiotic.

scholarly journals Ceftobiprole Perspective: Current and Potential Future Indications

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 170 ◽  
Author(s):  
Tommaso Lupia ◽  
Carlo Pallotto ◽  
Silvia Corcione ◽  
Lucio Boglione ◽  
Francesco Giuseppe De Rosa
Keyword(s):  
Bacterial Infections ◽  
Life Experiences ◽  
Real Life ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
Clinical Situation ◽  
Community Acquired Pneumonia ◽  
Severe Infections ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Ceftobiprole combines an excellent spectrum for community-acquired pneumonia (CAP) and hospital-acquired pneumonia (HAP) pathogens, with a low/medium MDR risk, and the β-lactams’ safety in frail patients admitted to the hospital in internal medicine wards which may be at high risk of adverse events by anti-MRSA coverage as oxazolidinones or glycopeptides. We aimed to report the available evidence regarding ceftobiprole use in pneumonia and invasive bacterial infections, shedding light on ceftobiprole stewardship. The clinical application and real-life experiences of using ceftobiprole for bloodstream infections, including infective endocarditis, are limited but nevertheless promising. In addition, extended-spectrum ceftobiprole activity, including Enterococcus faecalis, Enterobacteriaceae, and Pseudomonas aeruginosa, has theoretical advantages for use as empirical therapy in bacteremia potentially caused by a broad spectrum of microorganisms, such as catheter-related bacteremia. In the future, the desirable approach to sepsis and severe infections will be administered to patients according to their clinical situation, the intrinsic host characteristics, the susceptibility profile, and local epidemiology, while the “universal antibiotic strategy” will no longer be adequate.

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